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f <br /> APPLICATIt�`�1 FOR CONSTRUC7.bN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � HEATING SYSTEM: �C,AS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> I I DEMOLITION I � COMBINATION i I BUILDING �C�ECHANICAL I �PLUMBING SIGN <br /> OWNER MAILADORESS CITY 21P PHONE <br /> (i'-jZ'+,lk QRof'�x u�ol��l //�� Cm,�uUe ��e� �- aS�?-� <br /> TENANT MAILADORESS CITV ZIP PMONE <br /> ARCHRECTORDESIGNER MAILAODRESS QTY ZIP PHONE <br /> GENERAL GONTRACTOR MAIL AODrlESS CIN ZIP PHONE STA7E LICENSE• <br /> ii �2 �41F �cal �'i 5�� �A11,.�� tv.�� ' <br /> . M�AN RICONTPACTOR MRILAOORESS CITV 21P PHO� � FNSF , � <br /> � <br /> PWMBING CONTRACTOR ��AR ADORESS qiV ZIP PHONE STATc LICENS[s . <br /> CLA55 OF WORK ' <br /> I 1 NEW �, I qDDITION � : ALTERATION � REPAIR ��, . DEMOLITION '. ' WOODSTOVBFRPL INSERT I � BUILDING RELOCATION ,- <br /> � . <br /> LONTACT PERSON AND PHONE NO. ' r�,i� <br /> f <br /> CONTFRCT PRICE OF WONK — . �� <br /> � <br /> DTESCN,I�BE,W�_OHIK'ANO SOOARnE Fe TAGE�NVOWED � <br /> PR�ou��eK�oit+c�n �� � � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ^ , APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � S� ►.D� �!(AM.�.�/- PROVISIONS OF LAWS AND OFOINANCF.S GOVERNING THIS TVPE OF <br /> LEGAL SCRIPTIO FPROPERNI SYNBEIOWORARACNFOURCOPiES� yyORK WILL BE COMPLETED WITH WHElHER SPECIFIED HEREIN OR <br /> � �or BLOCN oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHCRITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 'Tj,�Q i i QS:i� �Z�,���-Q '(�" OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> i i in -�,sl�l_. PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TU PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE A(JD I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> ��/(0 �'���� SXiG�n n -- � /voAr�2 <br /> PRQIECTADDRESS <br /> urv ouswcss uccrvsc rvo <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATEF CLOSET(TOILET) � NC-�vHNDLG UNITS-H.P. <br /> �. BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> ' LAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. M � <br /> � _�— <br /> � SHOWER � CLOTHES DFYERS � <br /> VENTILATION FAN <br /> . KITCHEN SINK 8 DISP � FANGE HOOD —T <br /> DISHWASHEF <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE ' <br /> � URINAL METAL FIREP�ACE&CHIMNEY ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � . <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � _ <br /> ROOF DRAINS-RAINLEADEHS EXHAUST FAN ' <br /> SINK(SERVICE-BAR,ETC.) � � <br /> � <br /> � ' <br /> � <br /> i —T <br /> SUB TOTAL S SUB TOTAL S `�° ' <br /> PERMIT S � PERMIT $ / <br /> TOTAL FEE S ' TOTAL FEE S JS <br /> FOR OFFICE USE ONLY: <br /> RECEIPT NO. <br /> FRONTSETBACK REARSETBACK SIDESETBACK PLANCM��N��R FEE <br /> r <br /> J�J <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> BUILDING ' <br /> tYPEO�CONiS.AILOWABIE ttPEOFCONSi.ACIUAI occurqrvtr Nlorovrtwv6uNu5 � <br /> �"01P � PLUMBING <br /> 54EOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL �� ^ <br /> i <br /> OCCUPANCY LOAD FIRE SPRNKLERS REO'D HEIGHT IIMITA7i0Y <br /> ADDITIONAL PIAN CHECK � <br /> SPRINKLER i <br /> REASON FOR SPRMNLER$ � <br /> STATE BUILDING SURCHI.RGE � <br /> i , <br /> INTRNEBV PLANSAPP90VEOOY CITYOFEVERETT PUBLICYIORKS � � <br /> LOCAL SAI.ES � <br /> TAX CODE IS 3105 rorn� S"�; — <br />